Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2015; 6(7): 505-512
Published online Aug 18, 2015. doi: 10.5312/wjo.v6.i7.505
Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal
Tsuyoshi Ohishi, Masaaki Takahashi, Daisuke Suzuki, Yukihiro Matsuyama
Tsuyoshi Ohishi, Daisuke Suzuki, Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Shizuoka 430-0929, Japan
Masaaki Takahashi, Joint Center, Jyuzen Memorial Hospital, Hamamatsu, Shizuoka 434-0042, Japan
Yukihiro Matsuyama, Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan
Author contributions: Ohishi T wrote the paper; Ohishi T and Suzuki D operated on patients; Takahashi M and Matsuyama Y reviewed the manuscript and provided useful comments.
Conflict-of-interest statement: The authors declare no conflicting interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsuyoshi Ohishi, MD, PhD, Department of Orthopedic Surgery, Enshu Hospital, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka 430-0929, Japan. t-ohishi@ken.ja-shizuoka.or.jp
Telephone: +81-53-4531111 Fax: +81-53-4010081
Received: April 13, 2015
Peer-review started: April 24, 2015
First decision: May 13, 2015
Revised: May 27, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: August 18, 2015

Arthroscopic surgery of the posterior compartment of the knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury.

Keywords: Arthroscopic surgery, Knee, Posterolateral portal, Posteromedial portal, Transseptal portal

Core tip: Arthroscopic surgery in posterior compartment of the knee via the transseptal portal is less invasive to the patient compared to open surgery for access to the back of the knee. However, special care should be taken to avoid neurovascular injury when creating the three posterior portals. We have not encountered neurovascular injury with our procedure for creating a posterior transseptal portal in 161 treated knees, and conclude that it is safe and reliable.